Physiological Normothermic Machine Perfusion Enhances Kidney Preservation Versus the Established UK Normothermic...

Area of Science:

• Nephrology
• Transplantation Immunology
• Surgical Innovation

Background:

• Hypothermic preservation of donor kidneys causes graft injury, leading to high discard rates and nephron loss.
• Current clinical normothermic machine perfusion (NMP) protocols are limited by time-dependent injury.
• A novel physiological NMP (pNMP) protocol was developed to address these limitations.

Purpose of the Study:

• To compare the efficacy of a novel physiological NMP (pNMP) protocol against the current clinical NMP (cNMP) protocol for donor kidney preservation.
• To evaluate kidney preservation over a 12-hour perfusion period using paired preclinical models.

Main Methods:

• Paired porcine kidneys were retrieved and cold-stored, then randomized to either cNMP or pNMP.
• Both groups underwent 12-hour perfusion with continuous monitoring of hemodynamics, biochemistry, and urine output.

Main Results:

• pNMP kidneys demonstrated superior perfusion with stable hemodynamics and metabolic function within physiological ranges.
• pNMP preserved kidneys showed low NGAL levels, indicating improved tissue viability and stable urine output.
• cNMP kidneys exhibited hemodynamic compromise and acute kidney injury, with some deemed marginal for transplant, while all pNMP kidneys were suitable.

Conclusions:

• The pNMP protocol significantly enhances donor kidney preservation compared to the cNMP protocol.
• Prolonged organ preservation via pNMP could revolutionize kidney transplantation, enabling better post-transplant outcomes and increasing the donor organ supply.
• This approach may eliminate the need for immediate, night-time implantation and expand the donor pool.